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Coming Soon: The Big Book of American Smiles
The New York Times reports:
Previously unreleased figures from the Centers for Disease Control and Prevention show that in 2003 and 2004, the most recent years with data available, 27 percent of children and 29 percent of adults had cavities going untreated. The level of untreated decay was the highest since the late 1980s and significantly higher than that found in a survey from 1999 to 2002.
It's hard to think of a more obvious class signifier than bad teeth, especially as it grows more difficult to distinguish between income levels by other superficialities like dress. You can't buy a knock-off set of incisors at H&M. And given the correlations between physical attractiveness and financial success, a British smile is likely to reinforce crippling structural inequalities poor kids already face. For this they can thank the dental cartel:
Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to use dental hygienists and other non-dentists to provide basic care to people who do not have access to dentists.
Meanwhile, the A.D.A. does not support opening new dental schools or otherwise increasing the number of dentists. The association says it sees no nationwide shortage of dentists, though it acknowledges a shortage in rural areas. Dentists note that in the early 1980s, when schools were graduating nearly twice as many dentists relative to the overall size of the population as they are now, some dentists struggled to keep their practices afloat.
So back when the licensing system was liberal enough to force dentists to compete for patients, some of those dentists "struggled." Sorry kids, we can't have that.
|10.11.07 @ 12:23PM|#
Aha! So the justification for licensing, at least as far as the ADA goes, is to ensure that dentists don't have too much competition. Hoo-ha!
Episiarch|10.11.07 @ 12:24PM|#
Hey, gotta keep those dentist salaries propped up. Suck it up, poor rural people.
|10.11.07 @ 12:27PM|#
This is the sort of thing that, with a sufficient amount of attention, could ridicule the ADA into changing its tune.
|10.11.07 @ 12:29PM|#
Centuries ago, the state blocked medical classes, because they didn't want corpses defiled. Sigh, the more things change ...
|10.11.07 @ 12:38PM|#
This is the sort of thing that, with a sufficient amount of
attention, could ridicule the ADA into changing its
tune.
Hahahaha Fat chance chancelikely. The push for ending the ADA rent
regime, will never equal the ADA's commitment to keeping it.
|10.11.07 @ 12:43PM|#
The dirty secret is that being a dentist isn't really that hard. Filling a cavity is about as complex as refinishing a coffee table. Yet, dental school is nearly impossible to get into and a license to print once you get there. We really don't need people with elite intelligence to be dentists. Further, most basic dental care like cleaning and filling in small cavities can and should be done by trained dental assistants. It is all a scam.
Jozef|10.11.07 @ 12:49PM|#
The guy on the one dollar bill had wooden teeth; why should anyone had any better than that anyway?
|10.11.07 @ 1:14PM|#
I suspect that the obstacle for most people is the high cost of dental care. In a rational world, more dentists would equal lower prices. I'm not sure that it would make any difference in this world.
Episiarch|10.11.07 @ 1:18PM|#
This has nothing to do with insurance. At all. No
way.
Many insurance plans do not include dental. Many, many otherwise
insured people pay out of pocket for their dental care. And even
with dental coverage, the plans don't usually pay for much other
than routine care. Most will not pay for a (extrememly expensive)
root canal.
|10.11.07 @ 1:28PM|#
I have a dental plan, but my dentist still managed to bilk me for $700 this year. I had some extra work done, but don't try to tell me they'd still have the stones to charge me $100 just to get my teeth cleaned without the licensing racket.
|10.11.07 @ 1:37PM|#
For further reading regarding the situation in Alaska's Rural
Villages start
here.
Key quote from the Times' article:
Use of therapists would create a two-tier system where some people have access to dentists, while others must settle for less-qualified practitioners, she said.
Even if you have insurance, does it cover airfare or a two day boat
ride to get to the nearest Dentist? That is the reality of living
in the villages here and having ANY form of care is better than
none, the ADA be damned.
|10.11.07 @ 1:43PM|#
"This has nothing to do with insurance. At all. No way."
I long for the dental care enjoyed by well insured British.
Bill Pope|10.11.07 @ 1:48PM|#
Politely unmentioned here is that fewer jobs theses days offer a benefits package that includes dental. Rising tide that lifts all boats anyone?
ed|10.11.07 @ 1:57PM|#
The guy on the one dollar bill had wooden teeth
"W" (the first one) did not have wooden teeth.
Timothy|10.11.07 @ 2:10PM|#
Use of therapists would create a two-tier system where some
people have access to dentists, while others must settle for
less-qualified practitioners, she said.
As opposed to the two tier system where some people have access to
dentists and some people get to have woefully bad teeth and awful
mouth pain without any kind of treatment! Brilliant!
|10.11.07 @ 2:27PM|#
Eryk Boston | October 11, 2007, 1:36pm | #
Does this explain that fifth dentist who doesn't recommend
sugar-free gum?
I nominate Eryk's post as thread win of the year.
Asharak|10.11.07 @ 2:44PM|#
Good H&R piece. I was wondering why dental work is so ludicrously expensive.
Asharak|10.11.07 @ 2:52PM|#
This has nothing to do with insurance. At all. No way.
Insurance has a lot to do with it, but so does ADA meddling.
But I have to admit, I'm a bit surprised about Reason's
take on it. The general consensus from other "libertarians" on this
issue is that people who can't afford dental care brought it on
themselves by eating too much candy and not brushing enough.
anon|10.11.07 @ 2:58PM|#
"people who do not have access to dentists."
What - do they have no access to a toothbrush either?
Asharak|10.11.07 @ 3:17PM|#
What - do they have no access to a toothbrush
either?
That doesn't explain people who still get cativites even though
they brushed their teeth regularly and stayed away from sweets.
Thomas Paine\'s Goiter|10.11.07 @ 3:35PM|#
It's not class, it's bottled water
Exactly. Bottled water has no fluoride.
I think the dentist's are in cahoots with bottled water
companies.
|10.11.07 @ 3:48PM|#
"And this happy little fellow is the gouger"
No one else get the title? One of the best.
Don't these poor people realize their options? "These pre-date
stainless steel so you can't get them wet"
SIV|10.11.07 @ 4:14PM|#
So the justification for licensing, at least as far as the
ADA goes, is to ensure that dentists don't have too much
competition.
This is the only reason for all State required professional
licensing.
I am not one to usually call my fellow citizens
Stupid Fucking Morons but the epithet applies to
anyone who thinks the requirement is primarily to "protect the
public".
|10.11.07 @ 4:23PM|#
All I can say is that one look around at a legal conference will confirm that the state bar sure isn't in the business of keeping people out of the practice of law because they aren't smart enough.
Anonymo the Anonymous|10.11.07 @ 4:30PM|#
"Lisa needs braces... dental plan... Lisa needs braces... dental plan..."
|10.11.07 @ 4:43PM|#
Good link, Kwix, I was going to post the exact same thing about
the rural Alaska health care access. What a sham.
To summarize: The ADA doesn't want practitioners who are
"unqualified" to work in the remote villages of Alaska and the
government enforces it. However, because they artificially have
kept dentists' pay so high and rural Alaska cannot afford dentist,
there are no dentists out there. So everyone's teeth just
rot...
Not bad for a group who is "...committed to the public's oral
health..." (from the ADA mission statement)
Rhywun|10.11.07 @ 5:00PM|#
It's hard to think of a more obvious class signifier than
bad teeth
Rubbish. I grew up relatively poor but Medicaid took good care of
my teeth. True, I never got the braces I needed but that doesn't
mean I had "bad teeth". The health of your teeth is partly a
function of cultur...
I think some people are more prone to tooth decay that
others.
...and partly genetics. I have nasty, cavity-ridden teeth despite
reasonably good toothbrushing and reasonably regular visits to the
dentist. Whereas my ex had like two cavities and hadn't seen a
dentist in 10 or 15 years.
atrevete|10.11.07 @ 5:27PM|#
I suspect the health of your teeth may also be a function of
exposure to sunlight and/or sufficient vitamin D. I grew up in the
US and had lots of cavities. My kids grew up in Puerto Rico and NO
CAVITIES ever. The oldest got braces and when they came off - STILL
no cavities.
BTW, growing up I brushed my teeth just as often as they did -
twice daily - and I'd say they probably ate more sugar than I
did.
Russ 2000|10.11.07 @ 5:53PM|#
I always wondered why dental schools were closing, seemed like the profession attracted a lot of students. Guess I wasn't cynical enough.
|10.11.07 @ 7:55PM|#
Speaking of protectionism....
My father-in-law is a dentist in PA. He and his wife want to move
somewhere warm. Problem is he wants to keep practicing. There are
only a handful of states that will accept his PA licensing. Other
states require him to retake the licensing exam, and apparently it
is quite difficult to pass these exams if you are coming in from
another state in states where people are trying to move to (AZ,
Florida etc). It's well known in the dental community that this is
done to protect local dentists from competition and to make it very
difficult for out of state dentists to practice in those
states.
Joshua Holmes|10.11.07 @ 8:08PM|#
Killer fact: hunter-gatherers studied all over the world have
straight, white, uncrowded teeth and essentially no cavities. These
folks have never seen a toothbrush, drunk flouridated water, or
visited a dentist. But their diets are basically devoid of starch
and sugar, while rich in meat with its natural fat.
It should surprise no one that a population growing fatter by the
second is also suffering declining dental health. Bad diet is at
the root of both.
|10.11.07 @ 9:18PM|#
joe
This has nothing to do with insurance. At all. No way.
My firm offered a Dental Plan some years ago. I elected to not take
it.
Over the years since then my dental bills (out of pocket, including
regular checkups, two root canals and a three-crown-bridge) have
not come close to what I would have paid in "premiums".
joe, if you want to talk about the lack of a welfare scheme to pay
for poor people's medical and dental bills I'll listen. But,
please, stop calling it "insurance".
Chavez is a thug|10.11.07 @ 11:54PM|#
"The dirty secret is that being a dentist isn't really that
hard. Filling a cavity is about as complex as refinishing a coffee
table. Yet, dental school is nearly impossible to get into and a
license to print once you get there. We really don't need people
with elite intelligence to be dentists. Further, most basic dental
care like cleaning and filling in small cavities can and should be
done by trained dental assistants."
This is undoubtedly one of the most stupid and definitely the most
ignorant post I have ever read on this site. First, let's dispense
with the obvious. Most dentists don't do cleanings anymore anyway;
they are done by hygienists. As for your statements concerning the
filling of small cavities, this demonstrates you have absolutely no
knowledge of dentistry whatsoever. Who exactly determines if the
cavity is small prior to the excavation of the lesion? This
requires a clinical examination as well as the interpretation of
diagnostic images, usually taken by the assistant. I can think of
nowhere that trains assistants in the interpretation of
radiographs; the training hygienists receive is rudimentary, at
best, in this regard. To train them would result in a substantial
increase in time and resources for said training. Furthermore,
interpreting x-rays involves far more than just looking at them and
saying "ah-ha, a cavity."; caries detection is often difficult
enough in itself though. I daresay any court in the nation would
find you negligent if you focused only on cavities at the exclusion
of other radiographically-visible pathologies; these pathologies
can range from the very benign to the lethal. To be able to detect
and then make differential diagnoses concerning possible
pathologies requires quite a lot of training; most dental schools
require a mininum of 3-4 semesters of general and oral pathology.
Also, the detection of pathologies requires a knowledge of healthy
dental anatomy and histology to know the appearance of these
tissues at health. After all, you can't know if something is wrong
if you don't know what it normally looks like. It is obvious that
additional training would be required for this knowledge as well.
Dental assistants do not receive this kind of training (as a matter
of fact, many states require no training at all for the title of
dental assistant)and dental hygienists only receive the very
basics.
Back to the filling of small cavities. What would happen if there
was a carious or mechanical exposure of the pulp during this
process? Are you now advocating that dental hygienists be trained
in endodontics as well so that they can perform a pulpotomy or
pulpectomy on the patient? After all, with pulpal exposure, this is
probably the minimum that would be required. And if a pulpal
exposure is in doubt, are you going to train them to detect such
exposures radiographically in addition to teaching them the myriad
of diagnostics tests available to determine if a possible exposure
has occured?
But let us give these supremely-trained super assistants the
benefit of the doubt as far as pulpal exposures are concerned. Let
us just assume that once the lesion is opened up that it is larger
than imagined, without an exposure. Even if the lesion is initially
thought to be small enough to require no anesthesia, most patients
will demand anesthesia for larger lesions. The individuals
administering these shots will require a knowledge of the
neuroanatomy necessary to provide adequate anesthesia. There is
more to giving a shot than just sticking a needle in someone's
mouth and pressing down a plunger. You have to know which nerve
anesthetizes which portion of the mouth you are working on and
where that nerve is located. Furthermore, you have to consider
which anesthesia to use based on many factors including potential
allergic reactions, age and weight (particularly for pediatric
patients), whether to use an anesthetic with a vasoconstrictor,
usually epinephrine (an important consideration in individuals with
hypertension, as well as other conditions). Furthermore you must be
able to adequately obtain and interpret a patients health history
for many reasons, including the determination if antibiotic
prophylaxis is necessary prior to the administration of anesthesia.
All these factors require a knowledge, both academic and clinical,
that can only be obtained by a level of training no dental
assistant in this country receives; very few states allow dental
hygienists to administer anesthesia, and none that I know of let
them do it absent a dentist. And this is not merely because we want
to pad our wallets. They just do not receive the training. And the
additional time required for said training would make this whole
"let's have dental assistants do it" argument pointless, primarily
because the additional training would increase the cost and lower
the availability, both benefits that are assumed will exist once
the so-called "dental cartel" is broken.
Now, let us discuss the actual filling of the cavity. While it may
be easy to fill an extremely small cavity, as I made clear above
there is no guarantee it will be small once the excavation begins.
Larger cavities require much greater skill to excavate and fill as
one must take into consideration such factors as potential pulpal
exposures, the need for cavity liners, the patient's dental anatomy
and occlusion, the need to maintain contact with adjacent teeth
etc. When I attended dental school, I was required to see patients
six hours a day, five days a week, for the last two years of my
schooling to hone my skills. Knowing the extent of the training
received by assistants and hygienists, there is no way in hell I
would let them put a drill spinning at 100,000 rpm, at least, in my
mouth. As for your implication that all dentists do is fill
cavities, that is too stupid to comment upon further. In addition,
individuals with bachelors degrees in English would be wise not to
pontificate on dentistry and the skills and training required for
certain procedures as if they were experts in the field.
The implication contained within this article that dental
assistants (this is particularly laughable) and dental hygienists
receive enough training in school to be able to safely intrepret,
diagnose, anesthetize and then treat even basic dental problems is
absurd to the extreme. Furthermore, as I pointed out above, the
increase in the training cost and time involved would simply result
in an increase in the price of the services rendered and lower the
availability of these super-trained hygienists and assistants. What
would be the point? Moreover, there is no such thing as "safe"
basic care involving only the filling of cavities. What good is a
decay-free smile if the hygienist misses the extremely lethal
palatal melanoma or oropharyngeal carcinoma?
As for the asinine comments concering the intelligence of dentists,
dentistry is like any other profession. Good dentists, as well as
other medical specialists, are usually intelligent individuals .
Dentists are just doctors that happen to limit their practice to
the oral cavity. And from my personal experience, dentists and
dental students are easily as intelligent as M.D.s. I know because
I have a D.M.D and M.D. and I also have to put up with both to do
my job.
P.S. joe is an apologist for Chavez
Chavez is a thug|10.11.07 @ 11:57PM|#
"That doesn't explain people who still get cativites even though
they brushed their teeth regularly and stayed away from
sweets"
It is impossible to get a cavity if certain sugars, primarily found
in sweets, are not consumed. The initiation of a carious lesion
(the technical term for a cavity) absolutely requires the
consumption of sucrose.
atrevete|10.12.07 @ 2:05AM|#
DR Chavez is a thug (I know he is)
Then how come my soda drinking kids never got cavities? It really
is a mystery to me.
My mom would only let us have half a bottle of soda a week. I still
got cavities all over the place. My kids, on the other hand, would
drink that stuff at school all the damn time. Plus plantain chips
and empanadillas and God knows what else. No cavities. Very few of
their friends had cavities either.
Plus, there is a strong correlation between oral health and
cardiovascular health. So I still suspect consumption of sucrose is
necessary but not sufficient for your carious lesions.
|10.12.07 @ 5:51AM|#
I know because I have a D.M.D and M.D. and I also have to
put up with both to do my job.
Holy crap, did you take twelve years and spend $150,000 to go to
college? Also, not to impugn the intelligence of dentists, but I
think much of this thread has been about the ADA using the
government large and small to protect a monopoly on the profession
and make sure it stays lucrative.
Chavez is a thug|10.12.07 @ 6:05AM|#
"My mom would only let us have half a bottle of soda a week. I
still got cavities all over the place. My kids, on the other hand,
would drink that stuff at school all the damn time. Plus plantain
chips and empanadillas and God knows what else. No cavities. Very
few of their friends had cavities either. "
Genetics and oral hygiene play a factor in determining who and who
does not get cavities. Perhaps they have better oral hygiene than
you when you were a kid.
Chavez is a thug|10.12.07 @ 6:49AM|#
"Holy crap, did you take twelve years and spend $150,000 to go
to college? Also, not to impugn the intelligence of dentists, but I
think much of this thread has been about the ADA using the
government large and small to protect a monopoly on the profession
and make sure it stays lucrative."
It cost way more than that. Also it did not quite require twelve
years. After college, it requires 4 years of dental school, 2 years
of medical school and 4 years of oral surgery residency, of which
30 months must be spent on the actual surgical rotation.
I realize that the original article concerned the maintenance of a
monopoly. However I was responding to the absolutely idiotic
statement made by an individual who clearly has no idea what is
involved in the practice of dentistry. Anyone who suggests that
filling cavities properly is the same degree of difficulty as
finishing a dining room table is an ignorant jackass, plain and
simple.
Furthermore, I was hoping that my lengthy post would dispel the
myth concering so-called "simple" irreversible dental procedures
and who exactly is qualified to perform them. As I thought I made
abundantly clear in my post, dental hygienists and particularly
assistants do not receive the training required to make these
procedures even remotely simple, particularly when you consider
that the unexpected will inevitably arise during one of these
procedures. A whole heck of a lot more goes into performing these
procedures and providing a MINIMAL amount of care then just doing a
little buzz with the drill and sticking in some filling material.
It is criminally negligent in pretty much every state to fill
cavities and neglect other oral health issues. Again, dental
auxillaries are not trained to perform most of that additional
necessary work or even recognize the need for it, and the required
extra training would increase costs and limit the numbers of
practicioners to a degree that it would defeat the purpose, just as
I pointed out.
As I also pointed out to the person who started this thread, there
is an obvious misconception as to what is involved in performing
dentistry, or it would not just be blithely suggested that an
individual with a few months training would be adequately qualified
for the purposes of providing care in order to break a supposed
"dental monopoly". Perhaps a solution other than foisting
dangerously underqualified practioners on the unknowing public
should be suggested. And believe me, the comments have more than
proved that most people are absolutely clueless about dentistry and
oral health. And like I said before, individuals with a bachelors
in English usually have virtually no knowledge of dentistry and its
practice and thus should not be snarkily offering definitive policy
solutions as if they were an expert in the field.
Bill Crews|10.12.07 @ 8:21AM|#
For sake of clarity, I'd point out that even though dental care
is important, the premise in the study is simply wrong and based on
an erroneous NYT analysis of Public Use Data Files.
http://nchspressroom.wordpress.com/2007/10/11/the-new-york-times-and-oral-health/
|10.12.07 @ 9:38AM|#
Dr CIAT teeth have been around for hundreds maybe even thousands of years. Dentists only a fraction of that. Who took care of the teeth before the ADA? If you look at movies of ancient times you can see that people had nice clean teeth "Gladiator" is a good example.
|10.12.07 @ 11:20AM|#
CIAT,
Well, I'm glad you spent a quarter of a million dollars and only
ten years to be a medical doctor and a dentist! Look, I
didn't disagree with you- the comment you rebutted was pretty damn
ignorant. You made good points. You went to a fairly great length
to do so. And yes, people with liberal arts degrees don't have
business snarking off about how supposedly easy it is to do [insert
highly technical and potentially complicated task here]. But they
do possibly (hopefully) have the necessary faculties to
analyze policy. Join in on that.
burma,
As you pointed out yourself, Gladiator is a movie. I'm
sure Russell Crowe has had a lot of expensive bleaching and capping
done. I doubt Hollywood would sacrifice leading man sex appeal for
the sake of historical accuracy.
|10.12.07 @ 11:22AM|#
Oh, wait- you said after college. So that's more than ten years. Me count good.
|10.12.07 @ 1:35PM|#
CIAT,
You're exactly the kind of self-absorbed thug that libertarians
despise.
Do you know the difference in welding temperatures for Aluminum and
Steel? Flux characteristics and requirements?
Do you know the difference between a ganache and a glasse? How to
get carmelization without getting carbonization on a large scale
operation?
Do you know the proper petroleum/macadam ratio for humid climates
versus dry?
Would you have the slightest clue as to how to act in response to
your livestock limping on two hooves, but not four?
You're a prick because you think that the knowledge you spent your
life collecting is so inherently more valuable than the knowledge
non-professionals work their whole working lives to perfect that
you deserve to extort money from the unwashed with the guns and
courts of the govenrment and state houses.
XON, Esq. . .
Chavez is a thug|10.12.07 @ 2:47PM|#
"You're a prick because you think that the knowledge you spent
your life collecting is so inherently more valuable than the
knowledge non-professionals work their whole working lives to
perfect that you deserve to extort money from the unwashed with the
guns and courts of the govenrment and state houses."
Hahahaha, I laughed my ass off when I read this one. Yeah, I am
trying to extort money from people. That's a good one. Got anymore
ridiculous hyperbole you want to throw my way. And I'm a thug to
boot. Why don't you compare me to Hitler and get it over
with?
As for the ridiculous nonsensical properties of metal you were
asking about, exactly what do those have to do with anything even
remotely connected with this discussion? Absoltuely nothing.
Evidently you are so stupid, you missed the entire point of both of
my posts. Why else would you ask me the following: "Would you have
the slightest clue as to how to act in response to your livestock
limping on two hooves, but not four?" Somehow such stupidity is
supposed to be remotely connected with what I discussed. I will say
it again: Hygienists are not qualified to perform the tasks you
wish them to perform. I couldn't give two shits if an idiot like
you wants to accept it or not. When you are willing to have a nurse
with an associates degree diagnose heart problems then we can
discuss having a dental assistant perform dentistry.
In closing, what is the capital of Madagascar?
Who fucking cares because it is totally irrelevant to the
discussion, moron.
Chavez is a thug|10.12.07 @ 2:57PM|#
"But they do possibly (hopefully) have the necessary faculties
to analyze policy. Join in on that."
That is exactly what I am trying to do. The whole crux of the
argument here is the notion that assistants and hygienists can
perform enough dentistry own their own to allow them to practice
independently. As I have tried to demonstrate in my posts, this is
just not true. The whole argument the author puts forth quite
simply collapses under the weight of this fact. Some jackasses are
so touchy, they prefer to call me a thug instead of engaging in the
debate.
Chavez is a thug|10.12.07 @ 3:03PM|#
"....enough dentistry own their own..."
That should read on their own.
Chavez is a thug|10.12.07 @ 3:10PM|#
"Do you know the difference in welding temperatures for Aluminum
and Steel? Flux characteristics and requirements?
Do you know the difference between a ganache and a glasse? How to
get carmelization without getting carbonization on a large scale
operation?
Do you know the proper petroleum/macadam ratio for humid climates
versus dry?
Would you have the slightest clue as to how to act in response to
your livestock limping on two hooves, but not four?"
Actually, the answer is no to all of these questions. I am not
qualified to work in these fields. Thank you for making my point
for me.
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